Successful Conservative Treatment of Ovulation-Related Hemoperitoneum in a Patient With Congenital Hypofibrinogenemia: A Case Report and Review of Literature

Abstract

Intraperitoneal bleeding provoked by rupture of an ovarian follicle at ovulation or a corpus-luteum-cyst is not uncommon among women of reproductive-age. Usually, this is minimal and passes unnoticed. Massive hemoperitoneum is rare and is commonly associated with an underlying pathology. Patients with coagulation disorders or receiving anticoagulation therapy are exceptionally prone to develop massive hemoperitoneum that could at times be life-threatening if not identified and treated early. Very few cases of ovulation-related massive hemoperitoneum among afibrinogenemic/hypofibrinogenemic patients were reported to the literature. We present a case of congenital hypofibrinogenemia who presented with acute abdominal pain due to massive hemoperitoneum identified on ultrasonography. As the patient continued to be hemodynamically stable, on close monitoring of vital signs and serial hematologic parameters, conservative management with fresh frozen plasma (FFP) was started. This treatment modality was successful in inhibiting bleeding and ameliorating the clinical condition. The possibility of coagulation defects should be entertained in the differential diagnosis of acute abdomen with massive hemoperitoneum especially when no identifiable direct cause could be elicited. Conservative treatment aiming at conserving ovarian integrity and function has been successful in the management of cases with afibrinogenemic/hypofibrinogenemic and other bleeding disorders, thereby averting the need for surgical intervention. It should be the modality of choice in hemodynamically stable patients. Optimal management can be attained through careful clinical assessment and close follow-up by a multidisciplinary team including gynecologists, hematologists, surgeons and intensive care specialists. Ways to prevent recurrence should be accurately introduced to patients.

J Clin Gynecol Obstet. 2020;9(4):112-118
doi: https://doi.org/10.14740/jcgo628